Hideo Edamatsu

IgG4-related disease in the sinonasal cavity accompanied by intranasal structure loss

IgG4-related disease was recently proposed under the classification of systemic chronic inflammatory disease. In the field of otolaryngology, organ-specific diagnostic criteria have been established for the occurrence of this condition in the salivary glands, but not in the sinonasal cavity. Here we report a case involving a 70-year-old man with IgG4-related disease in the sinonasal cavity. The patient, with the chief complaint of nasal bleeding, first visited a physician. However, the patient experienced recurrent bleeding with intranasal structure loss and was subsequently referred to our hospital. His IgG4 level was elevated, and histopathological examination of a tissue sample obtained from the edematous sphenoid sinus showed increased IgG4-positive plasma cells and storiform fibrosclerosis. A definitive diagnosis of IgG4-related rhinosinusitis was made on the basis of comprehensive criteria for IgG4-related disease. The disease showed a progressively destructive course that was clearly different from that of chronic sinusitis and represented a very rare case of IgG4-related rhinosinusitis. IgG4-related disease originating in the sinonasal cavity is rare, and, to the best of our knowledge, this is the first primary case of IgG4-related disease that originated in one side of the sinonasal cavity and showed progressive destruction.

Identification of Onodi cell and new classification of sphenoid sinus for endoscopic sinus surgery

There is no effective classification method for the opening of the sphenoid sinus. The objective of this study was to examine the effectiveness of identification of the Onodi cell and classification of the sphenoid sinus using sagittal computed tomography (CT) for sphenoidotomy.

Efficacy of tonsillectomy for the treatment of immunoglobulin A nephropathy recurrence after kidney transplantation

BackgroundPost-transplant recurrent nephritis is the third common complication that leads to graft loss, which affects the long-term graft survival of kidney transplant patients. Immunoglobulin A nephropathy (IgAN) is the most common for recurrent nephritis, with a recurrence rate of 13–53%. In this study, 12 patients diagnosed with recurrent IgAN were divided into two groups, one which underwent tonsillectomy and another which did not, to analyze the effect of treating IgAN recurrent with or without tonsillectomy.MethodsUrinary findings, estimated GFR (eGFR), and histopathological alteration (Banff and Oxford classifications) were examined for >5xa0years after kidney transplantation.ResultsWe found that tonsillectomy protected graft function and prevented pathological alterations. The levels of urinary proteins increased in the no tonsillectomy group, whereas no difference was observed in the severity of hematuria between two groups. eGFR declined and mesangial hypercellularity score increased in the no tonsillectomy group.ConclusionsTonsillectomy not only results in a favorable clinical outcome but also protects against the histological damage caused by recurrent IgAN after kidney transplantation.

Primary adenoid cystic carcinoma of the nasolacrimal duct treated with proton beam therapy

Primary malignant tumors of the lacrimal passage, particularly of the nasolacrimal duct, are rare. We describe a 72-year-old woman who presented with lacrimation 5 years previously. She had pain and bloody and purulent lacrimation, and a mass was identified in the inferior meatus. Accordingly, she was diagnosed with primary adenoid cystic carcinoma of the nasolacrimal duct. She was treated with proton beam therapy and showed a favorable response. Owing to the long-term risks of recurrence and distant metastasis, adenoid cystic carcinoma requires sufficient follow-up.

Clinical Trend of Churg-Strauss Syndrome in Japan

Objective: There are a lot of reports that LTRA internal use, steroid medicine, and weight loss are associated with the onset of CSS. Because we experienced 2 cases of CSS that occurred during treatment of eosinophilic sinusitis this time, in addition, we consider some discussion from the literature. Method: We examined retrospectively 2 eosinophilic sinusitis patients, one with asthma and the other with allergic rhinitis. After these operations, we added wash-out sinuses and prescribed LTRA and nasal steroids. Depending on the state of intranasal findings, we gave steroid medicine. Results: We performed wash-out sinuses, LTRA internal use, and nasal steroids as postoperative treatment with both cases, and, at the exacerbation of intranasal findings, the intranasal findings improved by administration of steroid medicine. When we took steroid medicine, we did not do it with fixed quantity and the administration method that we did it and reduced. CSS was diagnosed by mononeuritis multipleand polyarthritis and purpuric onset subsequently. We suggested the possibility that LTRA internal use was associated with the onset of the CSS. Conclusion: LTRA internal use, steroid medicine, and weight loss may be associated with the onset of the CSS, and it is important to discontinue a causing agent when the otolaryngologist who frequently prescribes these drugs grasps overall status, and suspects CSS.

Alternaria Inhibits Defense Mechanism for Virus Infection

Objective: It has been suggested that fungi may have trigger effects for CRS. It was reported that PBMCs from CRS patients produced IL-5, IL-13 and INF-gamma by Alternaria. Kobayashi reported that Alternaria produced potent Th2-like adjuvant effects in the airway. We hypothesized that Alternaria inhibits Th1-type defense mechanisms against virus infection. Method: The functional responses were assessed by expression of cell surface molecules by FACS (MHC Class II, CD40, CD80, CD86, OX40L and CCR7). IL-6, IP-10, and I-TAC were measured by ELISA kits (R&D Systems). TLR3 mRNA and protein expression were detected by real time–PCR and Western blotting. Results: Alternaria and Poly I:C induced surface molecules of MHC Class II, CD40, CD80, CD86, OX40L, and CCR7 and IL-6 production in a concentration-dependent manner. But, Alternaria significantly inhibited IP-10, I-TAC, and IFN-gamma production induced by Poly I:C. TLR3 mRNA expression and protein production by Poly I:C were significantly inhibited by Alternairia. It was considered that these reactions were caused by heat-resistance and over 100 molecular weight substance from Alternaria. Conclusion: From these results, it was found that the presence of Alternaria inhibited a production of IFN-gamma by inhibiting expression of TLR3 and inhibited a production of IP -10 and I-TAC. Alternaria inhibits defense mechanisms against virus infection. It was suggested that Alternaria caused suppression for innate immune systems.